A new non-surgical technique has been developed to detect sperm in the testicles of men who have poor sperm production (non-obstructive azoospermia). Prior to the era of intracytoplasmic sperm injection (ICSI), these men were considered sterile. With ICSI, the requirements for sperm have been reduced to 1 live sperm per egg. Many men who have been diagnosed with non-obstructive azoospermia either due to hypospermatogenesis, maturation arrest or Sertoli-cell only syndrome (germinal cell aplasia) have been found to have small "pockets" of sperm production within the testicles. This observation has revolutionized an old concept that the testicle produced sperm in a uniform fashion and has lead to the new concept of "focal spermatogenesis". Sperm production has been found in up to 70% of men who have FSH (follicle stimulating hormone) levels greater than three times normal or who had no sperm production on a past biopsy.

Our challenge is to locate the areas of sperm production within the testicle and retrieve the sperm for use with ICSI. This is usually done as a diagnostic test and if usable sperm are found then the couple is recommended to proceed with ICSI. The procedure used to make the diagnosis is an open testiclar biopsy. This is a minor surgical procedure in which several small pieces of testicular tissue are removed and examined for sperm in the laboratory. A second biopsy is performed at the time of egg retrieval to get fresh sperm to use.

There is a non-surgical technique to test for the presence of sperm. A fine needle is used to aspirate a small amount of fluid and tissue from the testicle to ascertain if sperm are present. No incision is made and the procedure can be performed in the office with local anesthesia a light sedation. During the procedure a map of the testicle is created and this can direct the future therapeutic biopsy used to obtain the sperm at the time of ICSI. Since the future biopsy will be directed to an area of known sperm production, there is a greater chance of success and less chance of injury to the testicle. This is not as good a technique as the newer testicular micro dissection biopsy in terms of finding usable sperm at the time of IVF and does not allow for the recovery of enough sperm to freeze. It is a diagnostic technique only and we offer it to patients who request it.